González-Guzmán Diego, Andrade-Castellanos Carlos A, Ponce-Gallegos Marco A, Mesina-Estarrón Ignacio, Mora-Almanza José G, Ruelas-Moreno Hugo E, Rodríguez-González Daniel, Eguia-Ortega Omar, Colunga-Lozano Luis Enrique
Health science center, Universidad de Guadalajara, Guadalajara, Jalisco, México.
Department of Internal Medicine, Nuevo Hospital Civil de Guadalajara "Dr Juan I. Menchaca". Guadalajara, Jalisco, México.
J Intensive Care Med. 2025 Mar;40(3):284-293. doi: 10.1177/08850666241281281. Epub 2024 Sep 11.
COVID-19-related acute respiratory distress syndrome (ARDS) is linked to mortality, primarily due to a cytokine storm, oxidative stress imbalance, and pro-thrombotic state.PurposeWe assessed the potential association between N-acetyl-cysteine (NAC) and clinical outcomes in critically ill subjects with COVID-19-related ARDS.Material and MethodsWe included subjects with confirmed COVID-19 who were admitted to our ICU between March 1, 2020, and January 31, 2021, due to ARDS and necessitating invasive mechanical ventilation (IMV). Subjects who received standard of care (SOC) were compared with subjects who additionally received NAC 600 mg bid orally.ResultsA total of 243 subjects were included in this study. The results indicate significantly improved survival rates in the NAC plus SOC group, both in the unadjusted analysis and after adjusting for confounding factors such as ARDS severity (HR 0.48, 95% CI 0.32-0.70).ConclusionsWe found that oral administration of NAC was associated with reduced mortality in critically ill patients with COVID-19 related ARDS.
新型冠状病毒肺炎（COVID-19）相关的急性呼吸窘迫综合征（ARDS）与死亡率相关，主要原因是细胞因子风暴、氧化应激失衡和血栓前状态。目的我们评估了N-乙酰半胱氨酸（NAC）与COVID-19相关ARDS危重症患者临床结局之间的潜在关联。材料与方法我们纳入了2020年3月1日至2021年1月31日期间因ARDS入住我们重症监护病房（ICU）且需要有创机械通气（IMV）的确诊COVID-19患者。将接受标准治疗（SOC）的患者与额外口服NAC 600 mg bid的患者进行比较。结果本研究共纳入243例患者。结果表明，在未调整分析以及调整ARDS严重程度等混杂因素后，NAC加SOC组的生存率均显著提高（风险比0.48，95%置信区间0.32 - 0.70）。结论我们发现，口服NAC与COVID-19相关ARDS危重症患者死亡率降低有关。
